Diagnosis and tests for autoimmune hepatitis

You could learn you have a liver problem from your doctor. This is usually the result of routine blood tests, which include liver blood tests (or liver biochemistry tests).

If you have autoimmune hepatitis, you will have more liver enzymes in your blood. These are alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

If your liver blood tests keep being abnormal, you will have further blood tests to identify autoantibodies.

Autoantibodies include:

• Anti-mitochondrial antibodies (AMA)
• Anti-nuclear antibodies (ANA)
• Anti-smooth muscle antibodies (ASMA).

you will also be tested for another type of antibody, called immunoglobulin G (IgG).

If you have autoimmune hepatitis, you will most likely have higher levels of these autoantibodies and IgG in your blood. IgG is used as a marker to monitor the effectiveness of your treatment.

Blood tests are an important guide to who might have liver disease. But they aren’t accurate enough to rule out liver disease by themselves. If your liver blood tests are abnormal it is important that your doctor investigates. This could include more blood tests, a scan and often a liver biopsy.

If liver disease is suspected, scans can give doctors a more detailed picture of what is going on. These can include the following:

• An ultrasound scan looks at the surface and general shape of your liver, as well as any changes from its normal appearance.
• Transient elastography eg FibroScan®, measures the stiffness of your liver and helps your doctor judge how much liver scarring (fibrosis) there might be.
• CT and MRI scans can look at your liver in more detail.

Read more about scans and imaging tests here.

Blood tests and scans are not usually enough to make a diagnosis. If there is any doubt your doctor will recommend a biopsy. This can check for inflammation and scarring of the liver (fibrosis) to find out how advanced your liver disease is.

Your doctor should explain the risks and why they think having a biopsy is a good idea. This will help you decide for yourself if you agree (consent) to have one.

A liver biopsy might be an option if you are not responding to treatment, or your doctor wants to stop it at a later date. They might suggest a liver biopsy to make sure your liver inflammation has improved or gone away (remission).

Read more about liver biopsy here.

You might have an endoscopy to look inside your food pipe (oesophagus) and stomach to check for swollen veins (varices). If the varices are large and at risk of bleeding, your liver specialist can place rubber bands around them to cut off their blood supply (banding).

Liver cancer is more common if you have cirrhosis. Finding it early means it can often be cured. Doctors use regular checks (surveillance) every six months. This is to check for a type of liver cancer called hepatocellular carcinoma.